The changing scenario of hepatocellular carcinoma in Italy: an update

Abstract

Background and aims Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years. Methods Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004‐2008, 2009‐2013 and 2014‐2018). Results The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non‐viral cases and, particularly, of ‘metabolic’ and ‘metabolic + alcohol’ HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. Conclusions During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.

Surveillance as Determinant of Long-Term Survival in Non-Transplanted Hepatocellular Carcinoma Patients

“…Although in both LS and SS groups a relatively high percentage of patients (more than 50%) was diagnosed under surveillance, in the former group, surveilled patients were significantly more represented (67.9% vs. 55.7%; p < 0.0001). Despite the fact that these figures substantially differ from other experiences published in the literature, which reported <20% of cirrhotics undergoing surveillance [ 47 , 48 ], the percentage of surveilled patients in this study is in line with previous works of the ITA.LI.CA group [ 3 , 49 ].…”

Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis

“…EORTC developed clinical practice guidelines that recommend SR and MIS as first line treatment options for SHCC [ 89 , 90 ]. Surgical interventions involving the removal of the entire Couinaud segment containing tumors effectively eliminate the primary tumors.…”

Treatment of Hepatocellular Carcinoma with Immune Checkpoint Inhibitors and Applicability of First-Line Atezolizumab/Bevacizumab in a Real-Life Setting

“…Despite the benefit in OS with sequential TKI treatment, the prognosis of patients with advanced HCC remains poor [ 9 , 23 ]. The reasons for this include, besides the sub-optimal tumoricidal activity of these drugs, the progression of the underlying liver disease, the advanced median age of this cohort of patients (approximately 70 years), and the presence of substantial comorbidities, which are very frequent in these subjects and, overall, make them a particularly vulnerable cohort [ 24 ].…”